Andrew Coates: That's what you get when you kick the can down the road
"Kicking the can down the road" is an idiom that means to defer something crucial in hopes that the problem will become someone else's responsibility. The other day it occurred to me that "kicking the can down the road" has become a trademark of contemporary governments worldwide -- from the European debt crisis, to the so-called sequester, to the decision to defer changing the tax on New York's wealthy until a non-election year.
In many ways President Obama's "health care overhaul," the Affordable Care Act, is another example of kicking the can down the road. Here at the third anniversary of the reform, the bulk of the law will not begin to take effect until next year -- and its full process will continue through 2019, all the way to the Presidential election after the next Presidential election.
Perhaps then it is small wonder that the Kaiser Family Foundation Health Tracking Poll found this week that a solid majority of Americans, fifty-seven percent, have no idea what the impact of the Affordable Care Act will be. Three years after "health care overhaul" was signed into law we're still Waiting for Godot.
The Kaiser Foundation pollsters had the good sense to ask about things that were part of the debate four years ago but not part of the law. They found that a majority of people mistakenly believe that the reform will implement a so-called "public option" insurance plan. Four of ten people think that there are government "death panels" empowered to decide whether Medicare beneficiaries live or die, although this too has no basis in reality.
The real facts are not encouraging. Inadequate access to care, uninsurance, underinsurance, medical bankruptcy and state-by-state rationing of care for the poor remain the order of the day. The real experience for those in need of medical care has not improved. Indeed in many communities it has worsened.
Still, the Affordable Care Act promises private insurance for the uninsured -- starting next year. The plans offered through the state exchanges will be benchmarked to cover a minimum of 60 percent of the anticipated health care costs.
That means that a family plan purchased on the on the New York exchange will cost about $21,000 in a year in premium payments, plus an anticipated $12,500 in out of pocket expenses. Of course you can pay more if you want better coverage. In other words, starting this fall the uninsured will be able to sign up for unaffordable -- yet insufficient -- health coverage.
Families earning less that $92,000 will be given tax subsidies for insurance premiums, -- but each family eligible will face a significant, personalized, calculus problem about whether or not to purchase insurance.
The Kaiser Family Foundation's polling found that most people have no idea about this. I think this reveals popular wisdom. Some things we might rather not know! Cynicism and distrust of the anti-establishment that amounts to a healthy impulse.
The mainstream media consistently fails to lead with the facts. He-said, she-said reporting, with no grounding in facts, dominates. Casual attention to NPR and the daily papers invited the conclusions that both death panels and socialism were debated on Capitol Hill.
The real problem is that the Affordable Care Act kicked the can down the road, rather than taking responsibility for the health care crisis that the United States has right now. Small wonder that people don't know how the law will change the status quo -- when the ACA never aimed to to change the status quo in the first place. Unaffordable underinsurance will remain the best we can do.
That's what you get when you kick that can down the road -- until the day when the cans in the road block the way forward. Soon now we will all need to face the fact that nothing short of a public, national single-payer health program will be able to control costs, guarantee access to all, improve the quality of care -- and raise us all up.
Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.
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